Provider Demographics
NPI:1245375054
Name:AUSTIN, MICHAEL SHANE (DMD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:SHANE
Last Name:AUSTIN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2824B FARRELL CRES
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-1391
Mailing Address - Country:US
Mailing Address - Phone:270-648-1184
Mailing Address - Fax:270-852-5354
Practice Address - Street 1:2824B FARRELL CRES
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-1391
Practice Address - Country:US
Practice Address - Phone:270-648-1184
Practice Address - Fax:270-852-5354
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY73831223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics